Part Two: To mesh or not to mesh

November 30, 2015

Many women suffer in silence when they have a vaginal prolapse . However, if they decide to do something about it there are many decisions that need to be made.

It felt right for me to have my prolapse fixed now instead of putting my head in the sand hoping it would all go away. I did not want to wait until I had female urinary incontinence due to my prolapse, both common, though seldom discussed consequences of childbirth and ageing.

But who to see? My gynecologist retired years ago. I remember going to see Janet Duke when I was fifty-one and had debilitating period problems. I explained the drugs I was taking to alleviate the condition. She lent back in her chair, fixed me with a steely gaze and asked, ‘Is your husband still alive?’ ‘Yes’, I replied. ‘That’s a wonder’ she said smiling. ‘I thought you might have killed him by now.’ She went on to explain that the extreme levels of testosterone in my medication usually resulted in aggression. Alan was lucky. Instead of attacking anyone I hauled huge honeycomb rocks and placed them around the edge of a new garden. I look at them now and shake my head in wonder. I was a much calmer person after the hysterectomy.

The main cause of vaginal prolapse is the weak muscles, tissues, and ligaments that support the vagina, surrounding tissues and organs. The factors that can cause vaginal prolapse include frequent lifting of heavy objects, chronic cough, severe constipation, menopause, childbirth and advanced age.

Surgery is done to restore the vagina and the pelvic organs back to their respective positions and provide symptomatic relief. It helps to prevent further damage of pelvic floor muscles. Vaginal prolapse surgery may be done through laparoscopy or other forms of surgery.

There has been no need for a gynecologist since 1994. I spoke to my GP who had been to a lecture on prolapse at the Royal Women’s Hospital only the night before my visit. Armed with a referral to a well recognized surgeon I went home and intensively researched anything I could find on a bladder prolapse. There is a lot of information on the web but you have to be careful it is not just an advertisement. I decided to go to the source and looked up articles in medical journals.

The surgeon I was going to see practiced the latest techniques. He did keyhole surgery called Sacral colpopexy. In this procedure, one end of a strap of mesh is attached to the top of the vagina and the other end is attached to the upper part of sacrum situated at the base of the spine. When I saw him he discussed the procedure at length and took time to explain in detail what he recommended. It was a positive experience and I came out feeling that this may well have been the answer to many women’s problems.

However, I’m allergy prone, even to not using Elastoplast and also have an arthritic spine. I had seen reports in some of the journals that mentioned possible problems with the mesh. At a social gathering I met a friend who had this procedure done, had developed complications and was part of a class action against the mesh manufacturers. This led to more research. The details of the class action papers were very disturbing . Everyone is an individual and I seriously began to question if this procedure was right for me. Then the out of pocket expenses information arrived. The doctor’s fee was $2, 500 above medicare and my private health fund. I knew he was worth it but that’s a lot to find. One comment was, ‘You could go on a cruise around the islands for that’.

My GP, who knows Dr Lawrence, reassured me that he is an excellent gynecologist who for many years has been treating women’s problems and is constantly doing vaginal repairs. I immediately checked out the website and was suitably impressed, not only by the range of services offered but the obvious long term connection with well known hospitals. And he looked kind with just a hint of a quirky sense of humour.

The waiting room is full of women of all ages. Two young women are heavily pregnant and sit in comfy chairs. Hanging on the walls are cloth covered boards filled with pinned pictures of smiling parents and newborns. Many are cradled in Dr Lawrence’s arms. Thank you letters abound. ‘Thank you for our family bliss’ etc. Beside me sits and eighty-five year old woman . We flick through magazines, watch fish lazily swim around their aquarium and wait our turn.

After checking me out, Dr Lawrence talks about a procedure that he has done successfully for many years. No mesh, no external cuts, push the bladder, and anything else, back into position, and use self dissolving stitches to strengthen and repair the vaginal wall. He is positive, friendly and willing to discuss everything on my now long list of questions. He made it sound run of the mill, simple, an in and out job. Two nights in Cabrini and then home to rest and recuperate. Would I need pain relief, like morphine? Unlikely. Would I be able to take my Memoir Writing Class, for two hours, only a week after leaving hospital? Definitely. He was confident that the problem would be fixed and I believed him. But could it be so easy? It sounded too good to be true.

However, I decided to book in that day with Dr Lawrence at Cabrini Malvern for the tried and true method of repair.

No mesh for me.

I just wanted to get in, get done and get over it

I’ve just received notice that if anyone is interested, there is an Amazon promotion of the book by Ian Richardson, God’s Triangle . For the next 24 hours. it is being offered for free. This is an amazing opportunity to get your hands on a great book covering the true and touching story of why the marriage of Australian Baptist missionaries, Frank E. Paice and Florence M. “Florrie” Cox, fell apart in mysterious circumstances in East Bengal (now Bangladesh) during the First World War. An investigation into why the Supreme Court of Victoria in Melbourne considered the divorce so sensitive that the file was ordered to be “closed for all time”. It is well researched and a thought provoking story.

Thanks, Mairi for all your support and encouragement. I hope this journey helps other women. I hate to think of how many older women suffer in silence with a non life-threatening complaint that can be repaired.